TLH: Not medically necessary?!

I am scheduled for surgery on June 28th, and found out yesterday that my insurance has denied the claim as not medically necessary! I've had a previous lap 3 years ago to remove cysts and endometriosis. My doctor has already appealed saying this is in my best medicsl interest but I'm nervous about the denial. He says its common and not to worry. Has anyone else battled insurance approval issues? Thanks! - Amy

I have not battled a denial, but what felt like was going to be a denial. It depends upon your insurance, but at the end of the day your doc is your best advocate and he sounds like he has dealt with this before. In my case insurance was asking my doc's office all sorts of questions about whether certain procedures were done, how he was going to perform the procedure, etc. The doc's office was a little worried it would take more effort to get it approved, but it was ultimately approved. I also gave the the insurance company a call to find out what was going on, as we pay the premiums for coverage. Sometimes the squeaky wheel gets the oil, so I was being a little sqeaky.

Sending positive vibes your direction that your doc gets approval through appeal and everything happens as scheduled.

With endometriosis, the denial could be a blessing in disguise, depending on how you look at it.

Is your surgeon a specialist? With insurance involved and having 3 unsuccessful laps, I am guessing not. Are you aware that a hysterectomy is not a cure for endometriosis and may have little or no affect on endometriosis symptoms? That's because endo exists outside the uterus, so removing the uterus doesn't take care of the endo.

Have you had a second opinion with someone who specializes in treating endo to see if s/he could possibly avoid a hysterectomy and/or find and remove all the existing endo and remove it using a superior method so that you could have a better chance at the symptom relief you are looking for?

I would just hate for you to have a similar experience to me--hysterectomy (with complications) followed by surgery with a specialist to take care of all the endo my OB/GYN couldn't touch. he also had to clean up all the new endo and all the adhesions from the hysterectomy, complications, and endo. It would have saved me a lot of time and money, and my health would have been better, had I seen the specialist in the first place!

Hysterectomy does NOT cure endometriosis and if you keep ovaries (as you should of you can) it doesn't cure that. Hysterectomy is a radical and LIFE altering surgery. I shouldn't have had mine Jan 2015. Regret is a mild word.

20 years ago my endo was debilitating and there was discussion of possibly needing a colostomy bag in the future. I wasn't ovulating and had a blocked tube. I was devastated when they didn't do the hysterectomy. It was my last hope I clung to. By the way before I had endo everywhere. Bladder, ureters, bowel, cul de sac, everywhere. Could barely walk some days and debilitating is a mild word at best.

Thank god they didn't do it then. I now have 3 children. One with clomid for ovulation. The other two drug free and after the many surgeries and dye through my tubes one day both tubes were both open. During csectio. no visible Endo. I still had flooding during periods which wiped me out. An ablation fixed that. 3 days of period that was so light and no craps each month was heaven.

8 yrs later or so I got some bad abdominal pain that lasted a few day. I had an ultra sound that found pockets of fluid in scar tissue. Answer was hysterectomy. Now if they can do fetal surgery in the womb and aspirated a breast lump with a needle then why couldn't they simply go in and open the pocket and remove the scar tissue causing it INSTEAD of a hysterectomy???

My life was fantastic before surgery. My periods were light happy spotting episodes. I had energy, good skin and hair, happy attitude, fit body, and a sex drive like a man. A good life.

Now I can't do my job. I'm physically exhausted. Dry skin that flakes off my face and cracked feet despite the many pedicures, my hair barely grows and is brittle and thin, I'm cranky and snappy. I need naps.

I've had two other procedures to remove sutures and granulated tissue. Last one was a week ago. That's a year and a half after surgery. If I move wrong my intestines get caught n twisted in my mesh uterine suspension "the new soft good mesh" which is extremely scary.

Hysterectomy is not a cure for anything other than cancer and massive fibroids.

Thank you all for the support and advice. My doctor has explained this is not 100% cure all but given my history and some other personal factors, we feel it is the best option right now. I found out today that the surgery has been approved so I am happy and anxious for things to go on as planned!

	Quote:
Originally Posted by Alnorgr523 Thank you all for the support and advice. My doctor has explained this is not 100% cure all but given my history and some other personal factors, we feel it is the best option right now. I found out today that the surgery has been approved so I am happy and anxious for things to go on as planned!

I'm glad to read this. I'd been following your dilemma, even though I had no advice to offer. Hope you get a confirmed date soon!